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Including Pupils with Down's Syndrome. Secondary Education

Sandy Alton
Specialist Advisory Teacher, Oxford LEA
Published by: The Down's Syndrome Association (UK) 		  Reprinted with the permission of Bob Black, Education Information Officer
The Down's Syndrome Association (UK)
4 Fairfield Road, Falmouth
Cornwall TR11 2DN

Aim of this Booklet:

Many more pupils with Down's syndrome are now entering mainstream schools. This is the result of several factors. Pressure from parents with support from voluntary organisations led to the 1981 and 1993 Education which encouraged LEAs to integrate pupils with special needs into mainstream schools if the parents so wished; more recently the 1997 Green Paper, Excellence for All Children: Meeting Special Educational Needs, with its push for inclusion, proposed that more pupils with SEN should attend mainstream schools.
Inevitably, many teachers will find the idea of including pupils with Down's syndrome into their classrooms daunting and will initially be apprehensive. However, experience shows that most teachers have the skills to understand these pupils' particular individual needs and are able to teach them effectively and sensitively.
This booklet is to inform teachers about the learning profile typical of pupils with Down's syndrome and good practice in their education, thus paving the way to successful inclusion. It also includes a number of quotations drawing on a specific case history of a pupil attending a mainstream secondary school.

Why Inclusion

There are many reasons why a pupil with Down's syndrome should be given the opportunity to attend mainstream school Increasing amounts of research rave been published enhancing knowledge about he capabilities of children with Down's successfully syndrome, and their potential to be successfully included, while parental awareness of the value and the benefits of inclusion has grown. Moreover, inclusion is non-discriminatory and brings both academic and social benefits

Academic

Social

Successful inclusion is a key step towards preparing pupils with SEN to become full and contributing members of the community, and society as a whole benefits. Typically developing peers gain an understanding about disability, about tolerance and how to care for and support other pupils with special needs. As David Biunkett writes, in his Foreword to the 1997 Green Paper "[where] all children are included as equal partners in the school community, the benefits are kit by all".

A Positive Attitude

However successful inclusion does not happen automatically: Experience shows that one of the most important ingredients in successfully implementing inclusion for pupils with special needs is simply the will to make it succeed. The attitude of the whole school is therefore a significant factor a positive attitude solves problems of itself. Schools need a clear and sensitive policy on inclusion and senior management teams which are committed to the policy and supportive towards the staff, helping them develop new skills within their classrooms.

Some Facts about Down's Syndrome

A Specific Learning Profile Not Just Developmental Delay

Pupils with Down's syndrome are not just generally delayed in their development and therefore merely in need of a diluted curriculum. They have a specific learning profile with characteristic strengths and weaknesses. Being aware of the factors that facilitate and inhibit learning will allow teachers to plan and implement meaningful and relevant activities and programmes of work. The characteristic learning profile and learning styles of the pupil with Down's syndrome, together with individual needs and variations within that profile, must therefore be considered.
The following factors are typical of many pupils with Down's syndrome. Some have physical implications; others have cognitive ones. Many have both.

Factors that Facilitate Learning

Strong visual awareness and visual learning skills including:

Factors that Inhibit Learning

A brief account of each of these inhibiting factors follows, with some strategies to address them which make use of the pupils' likely strengths and weaknesses in order to build a successful teaching programme. Many of these strategies will be recognisable as basic good teaching practice and so will be equally suitable for other pupils in the school.

Visual Impairment

Although pupils with Down's syndrome tend to be very good visual learners and are able to use this strength to access the curriculum, many have some sort of visual impairment: 60-70% being prescribed glasses before the age of seven and it is important to allow for any specific visual impairment they may have.

Strategies:

Hearing Impairment

Many children with Down's syndrome experience some hearing loss, especially in the early years. Up to 20% may have a sensorineural loss, caused by developmental defects in the ear and auditory nerves. Over 50% are likely to suffer from a conductive hearing loss due to glue ear caused by frequent upper respiratory tract infections which often occur as a result of smaller sinuses and ear canals. It is particularly important to check pupils' hearing, as this will affect their speech and language.
Clarity in hearing can also fluctuate daily and it is important to ascertain that inconsistencies in response are due to hearing loss rather than lack of understanding or poor attitude.

Strategies:

Fine and Gross Motor Skills

Many children with Down's syndrome have poor muscle tone and loose joints, (hypotonia), affecting their motor co-ordination. Pupils may have more difficulty participating in team games and small group or partner activities with set objectives may need to be provided. In the classroom, the ability and speed at which pupils with Down's syndrome can write can be particularly affected.

Speech and Language Difficulties

Pupils with Down's syndrome typically have a speech and language impairment and should be seen regularly by a Speech and Language Therapist who can suggest individualised activities to promote their speech and language development.
The language delay is caused by a combination of factors, some of which are physical and some due more to perceptual and cognitive problems. Any delay in learning to understand and use language is likely to lead to cognitive delay. The level of knowledge and understanding and thus the ability to access the curriculum will inevitably be affected. Receptive skills are greater than expressive skills. This means that pupils with Down's syndrome understand language better than they are able to speak it. As a result, their cognitive skills are often underestimated.

Common Features of Delay in Language Acquisition:

In addition, the combination of having a smaller mouth cavity and weaker mouth and tongue muscles makes it harder to physically form words; and the longer the sentence, the greater the articulation problems become.
Speech and language problems for these pupils often mean that they actually receive fewer opportunities to engage in language and conversation. It is more difficult for them to ask for information or help. Adults tend to ask closed questions or finish a sentence off for the child without giving them much needed time or help to do it themselves.
This results in the pupil getting:

Strategies:

Poor Auditory Short-Term Memory and Auditory Processing Skills

Other speech and language problems in children with Down's syndrome stem from difficulties with their auditory short-term memory and processing skills. The auditory short-term memory is the memory store used to hold, process, understand and assimilate spoken language long enough to respond to it. Any deficit in short-term auditory memory will greatly affect pupils' ability to respond to the spoken word or learn from any situation entirely reliant on their auditory skills. In addition, they will find it more difficult to follow and remember verbal instructions.

Strategies:

Remember: children with Down's syndrome are strong visual but poor auditory learners. Wherever possible, they need visual support and concrete and practical materials to reinforce auditory input.

Consolidation and Retention

Pupils with Down's syndrome generally take longer to learn and to consolidate new skills and the ability to learn and retain can fluctuate from day to day.

Strategies:

Structure and Routine

Many children with Down's syndrome thrive on routine, structure and clearly focused activities. Unstructured and informal situations are often more difficult for them. Equally, they can be easily thrown by any change. They may need more preparation and may take longer to adapt to changes in the classroom and to transitions.

Strategies:

Behaviour

There are no behaviour problems unique to children with Down's syndrome. However, much of their behaviour will be related to their level of development. So, when problems occur, they are generally similar to those seen in typically developing pupils of a younger age.
In addition, pupils with Down's syndrome have grown up having to cope with more difficulties than many of their peers. Much of what they are expected to do in their everyday lives will have been much harder to accomplish due to problems with their speech and language, auditory short-term memory, motor co-ordination, shorter concentration span, and learning difficulties. The thresholds that trigger problem behaviours may therefore be lower than with their typically developing peers, i.e. they are likely to become frustrated or anxious more easily. Having Down's syndrome does not lead inevitably to behavioural problems; but the nature of their difficulty makes these pupils more vulnerable to the development of behaviour problems.
A particular aspect of problem behaviour is the use of avoidance strategies. Research has shown that, like many pupils with special needs, pupils with Down's syndrome tend to adopt such strategies, which undermine the progress of their learning. Some pupils tend to use social behaviours to distract adult attention and avoid learning and seem prepared to work only on tasks which fall within a very narrowly defined cognitive range.
In the secondary years, the increasing cognitive demands will often be at the root of inappropriate behaviour. Recognition of this is critical in responding to behaviour problems. It is important to remain alive to the possibility of avoidance, to separate immature behaviour from deliberately bad behaviour, and to ensure that the pupils' developmental, not chronological, age is taken into account, together with their level of oral understanding. Any reward offered also has to take account of these factors.

Strategies:

Support

A Learning Support Assistant (LSA)* will support most pupils with Down's syndrome in secondary schools. However, the type of support the pupil receives can have a tremendous impact on the effectiveness of the inclusion and it is important that the role of the supporter is planned in advance and carefully established to everybody. In addition, in order to ensure inclusion in the lesson, it is vital that the pupil receives some personal interaction with the class teacher.
The following are useful guidelines when considering the role of the LSA:

In Terms of the Pupil:

In Terms of the Teacher:

It is also important that the LSA is seen as belonging to the whole class, giving help to all pupils in need of it, and not seen, as only belonging to the pupil with Down's syndrome. In this way, other pupils in the class can benefit from extra help and care too. The teacher must not abdicate responsibility for the pupil with Down's syndrome to the LSA.

One-to-One & Withdrawal

In addition, support should not consist only or even primarily of the LSA working with the pupil in a one-to-one situation, especially if it involves withdrawal from the class, which should be avoided if possible. Although there will be times when some one-to-one is needed, this should be given only when absolutely necessary and should be within the classroom if at all possible.

*The term Learning Support Assistant is used for convenience, throughout this text. There is some regional variation throughout the UK and in Scotland new funding 1999-2000 created a new staffing level within schools, Learning Support Assistant/Auxiliary: Classroom Assistants whose role it is to prepare resources etc for the teacher. The term Special educational needs Co-ordinator or "SenCo" is used. However, in Scotland the title is "Principal Teacher Learning Support".

Strategies:

Be aware that too much one-to-one support can result in the pupil failing:

How Many LSAs?

In secondary school the opportunity often arises to consider several ways of organising support. Generally speaking, it is not advisable to have one LSA to support a pupil. It can create overfamiliarity and over-dependency on one adult and is very intense for both pupil and LSA.
Encouraging pupils with Down's syndrome to become independent in their learning and social skills is also an important aim at secondary level and a single LSA may not promote these skills.
In addition, having to cope with a range of different subjects at secondary level is difficult for one LSA: some will have more expertise at supporting a pupil in one subject than another. Many secondary schools have LSAs who are subject-based, covering perhaps two to four subjects each. This enables them to become more subject expert and improves liaison between them and the subject teachers. Most pupils with Down's syndrome are able to cope with this arrangement as long as the range of LSAs is not too great and a consistent routine is kept to.

Planning Support

SenCos*, class teachers and support staff need to meet regularly to plan, communicate, feedback and monitor progress. A communication book for all involved to record plans, notes, ideas and feedback is often invaluable, especially where more than one LSA is involved with the child.
When planning support, it is important to decide: The class teacher or SenCo is ultimately responsible for differentiating activities but many LSAs are capable of adapting the activities further, if and when necessary. However, any extra time that this involves must come out of the LSA's support hours and time should be allocated for this to happen.
Decide when the child should work: And when the child is to be: Plan an Individual Education Plan (IEP) to target specific areas needing special attention.

Learning Support Base

In secondary schools, it is necessary to decide the way the learning support resources are organised and managed. It is desirable to establish a learning support base, probably no more than a room, which can act as a focus for these resources. If used well, such provision allows a wide range of opportunities to facilitate inclusion. It is available to be used in a wide range of ways to all staff as well as Sencos, LSAs and other support staff.
It can be used:

Social Inclusion

All pupils with Down's syndrome benefit from mixing with typically developing peers. They are often very keen to do the same as their peers and generally use them as role models, for appropriate social behaviour and motivation for learning. This type of social inclusion, where the other pupils are setting normal expectations for age-appropriate behaviour and achievement, is extremely important for pupils with Down's syndrome. In addition, friendships and social experiences from the secondary school years are very important in forming future relationships and helping youngsters adapt to different social situations. Even so, many often need additional help and support in learning the rules for normal and appropriate social behaviour. They do not learn well from incidental learning and will not pick up conventions instinctively as do their peers. They may take longer to "learn the rules" than their typically developing peers.
In addition they may not have sufficient language skills to form friendships easily and sustain them. They may become increasingly aware that they are different, making it harder to mix with their peers as the developmental gap between them and their peers grows wider with time.
Therefore, pupils may need additional help to:

Strategies:

Robert is embarking on a long journey in this respect but he is winning. At first there were problems at break and lunchtimes because Robert wanted to be with the students who made him the centre of attention. Some older boys were encouraging him to perform like a clown until he became excited and very silly. The boys were advised that they were not exactly helping him and Robert was encouraged to attend a lunchtime club run by LSAs for vulnerable students. Robert still enjoys socialising out and about in the school but is beginning to learn about friendships. The other day he was very upset (for about five minutes!) because he didn't have a girlfriend like the other boys - yes, he copies other students, but that is why he attends a mainstream school. Robert has taken part in visits including a day trip to France to practice his French. He has been included in many school and form activities like singing in the Christmas concert and swimming for his form in the Swimming Galas.

The Curriculum

The developmental gap between pupils with Down's syndrome and their typically developing peers widens with age, often becoming a major issue in the secondary years. Some pupils may be still working towards level 1 (W) in certain subject areas on entering secondary school, but others will be working towards higher levels. Abilities in reading and literacy skills tend be higher than ability in numbers.
Curriculum planning and differentiation tend to become more challenging over time and they are at their most complex by the time a pupil reaches Key Staged 4. This is recognised in The Code of Practice on the Identification and Assessment of Special Educational Needs which recommends: There is a one balance between the subject content and a pupil's individual needs. Some areas of the curriculum will be much more accessible than others. How much of the curriculum is appropriate with Down's syndrome will vary with each individual and the quality of the learning experience teas to be assessed as much as the learning outcome. The keynote is flexibility in approach and content.
Curriculum planning at this stage may involve drawing upon a wide range of material and include programmes of study from any Key Stage where the level is more appropriate to the pupil. It may be that the lesson for the pupil with Down's syndrome should focus on one key point only Good differentiation, careful grouping and peer support, additional adult support when necessary and additional use of visual and concrete resources can all help the pupil with Down's syndrome gain some knowledge, skills and understanding from most lessons.
Supporting the Target Setting Process, DfEE, (1998) is a useful booklet to help schools set targets and assess achievement for pupils with SEN who are working below Level 1 and between Level 2 National Curriculum in English and maths. Performance criteria in personal and social development are also included.

Classroom Practice

Many pupils with Down's syndrome, as with many pupils with SEN, do not cope well with a number of classroom practices, common in many secondary schools such as whole class teaching, learning through listening and follow up work based on the completion of unmodified text activities or worksheets. Therefore, teachers may need to look at their classroom practice and the whole learning environment of the class, so that activities, materials and pupil groupings are all taken in account.
It is important, for example, to utilise the motivation of many pupils with Down's syndrome to learn from their peers. For some purposes, ability will be less important than pupils' learning styles and attitude/behaviour. However, much grouping in secondary schools tends to be based upon ability. In addition, pupils with SEN tend to be withdrawn as a small group - perhaps to work in a Learning Support room.
This type of low ability grouping is probably appropriate in certain circumstances, but too much denies pupils opportunities to learn from others with a wider range of ability and in different situations. In addition, pupils with Down's syndrome often take their cue from those with whom they are working and will tend to pick up any behavioural problems displayed within the group. If work is suitably differentiated, pupils with Down's syndrome can benefit from working with more able pupils who may be good role models in terms of motivation and behaviour and need not always be placed with other pupils with SEN.

Independence and Life Skills

Developing independence and life skills for pupils with Down's syndrome in order to prepare them for all pupils. However, most of their peers will learn these skills automatically whereas the pupils with Down's syndrome will need additional help. These pupils need not be taught in isolation, however, as there are always other pupils who will benefit from such additional sessions. Life skills can also be taught through accredited schemes (see below).
When it became apparent that he was struggling in his Maths lessons, Robert and a few others in the class were put on individual programmes. In addition Robert and another student were withdrawn from mixed ability History lessons for a term to enable them to have more concrete experience of learning money handling skills. The visits in the community took place at this time to maximise opportunities to develop speaking and listening skills as well as life skills. Robert also built a model of Stevenson's 'Rocket' as his contribution to the Industrial Revolution being taught in History at the time. However Robert has missed very little of the curriculum. He still learns French and has made steady progress in most subjects.

Homework

Difficulties with language and short-term memory can make remembering what is expected for homework particularly difficult for pupils with Down's syndrome so communication over homework is particularly important. It can also take a pupil with Down's syndrome much longer to complete homework than their peers so it is important that all homework is suitably differentiated in terms of content and time.

Strategies:

Homework has been one of the biggest problems especially during Year 7. Much discussion and note writing took place between home and school to ensure that Robert completed his homework. Sometimes the homework was set at too high a level for Robert and this had to be communicated to his teachers. At one point Robert's teachers were asked to restrict the homework to only one subject per night.

Accreditation at Key Stage 4

By the end of Key Stage 4, there will be a wide range in the level of attainment achievable by pupils with Down's syndrome. Some will be capable of achieving a GCSE grade in certain subjects. Where this is not possible, however, suitable and appropriate alternatives should be offered. Moreover, such schemes should have national recognition. It is important, therefore to address a number of questions when planning the curriculum for pupils with Down's syndrome at Key Stage 4: There is, in fact, a range of high quality alternative qualifications available to schools for pupils working below the level of GCSE or Foundation GNVQ.
Many of these are accredited as Entry Level qualifications. Syllabuses are designed for pupils at Key Stage 4 who are at levels 1, 2 or 3, or who are borderline GCSE candidates. Some, as in many of the Certificates of Achievement, offer progression towards GCSE or key skills units. Many are designed to allow co-teaching with GCSE courses, thereby enabling the teacher to enter candidates for both GCSE and Certificate of Achievement in the same subject, or to defer entry decisions until January or February of Year 11.

The Future

Each year, we hear more and more accounts of young adults with Down's syndrome who are working and living independently, gaining more qualifications and experiences, learning to drive and succeeding in a wide variety of jobs. Creating appropriate opportunities for them to understand their world, to learn and to progress to their full potential is the first step towards preparing them for true inclusion into the community and to go on to take their place as full and contributing members of society.
Robert will be having his 14+ Review this year and we will be helping him to plan for the future. At Key Stage 4 he will be able to take a number of practical subjects geared for less academic students. He may take accredited courses including Youth award and Certificate of Achievement or GCSE examinations. Robert will take part in Work Experience and may choose to attend link courses at the FE College. The school aims to give Robert the means to be a normal and happily adjusted member of his local community, and in so doing are attempting to encourage Robert's fellow students to be aware of the needs of others.

A Short Bibliography

ALTON, S. (1998) Differentiation not Discrimination: Delivering the Curriculum for children with Down's syndrome in mainstream schools. Support for Learning 13(4), 167-173.
BRUNI, M. (1998) Fine Motor Skills Children with Down Syndrome, A Guide for Parents and Professionals. Woodbine House.
BRYAN, J. (1998) Living with Down's Syndrome. Wayland.
BUCKLEY, S. and BIRD, G. (1994) Meeting the Educational Needs of Children with Down's Syndrome: A Handbook for Teachers. Portsmouth: University of Portsmouth.
BUCKLEY, S. and BIRD, G. (1993) Teaching Children with Down's Syndrome to Read. Down's Syndrome: Research and Practice 1(1) 34-41.
BUCKLEY, S. and BIRD, G. (1998) Including Children with Down Syndrome. Down Syndrome News and Update, Vol 1(1) 5-13.
BUCKLEY, S. and BIRD, G. (1998) Including Children with Down Syndrome (Part 2). Down Syndrome News and Update, Vol 1(2) 60-66.
BUCKLEY, S. (1995) Teaching Reading to Teach Talking: Important New Evidence. Portsmouth Down's Syndrome Trust Newsletter 5(5) 1-6.
BUCKLEY, S. (1999) Improving the Speech and Language Skills of Children and Teenagers with Down Syndrome. Down Syndrome News and Update, Vol 1(3) 111-128.
DEPARTMENT for EDUCATION and EMPLOYMENT (1997) Excellence for All Children: Meeting Special Educational Needs. London, HMSO.
DEPARTMENT for EDUCATION and EMPLOYMENT (1998) Supporting the Target Setting Process (Guidance for effective target setting for pupils with SEN). London, HMSO.
FLYNN, M. and P. (1998) Think About Having a Leaming Disability. Belitha Press.
GROSS, J. (1995) Special Educational Needs in the Primary School - A Practical Guide. OUP.
LAWS, G., BUCKLEY, S., BIRD, G., McDonald, J., and BROADLEY, I. (1995) The Influence of Reading Instruction on Language and Memory in Children with Down's Syndrome. Down's Syndrome: Research and Practice 3(2) 59-64.
LEWIS, A. (1995) Primary Special Needs and the National Curriculum. Routledge.
LORENZ, S. (1998) Children with Down's Syndrome. A Guide For Teachers and Learning Support Assistants in Mainstream Primary and Secondary Schools. David Fulton.
LORENZ, S. (1999) Supporting Support Assistants. Downright Press.
LORENZ, S. (1999) The Support Assistant's Survival Guide. Downright Press.
OELWEIN, P. (1995) Teaching Reading to Children with Down Syndrome, A Guide for Parents and Teachers. Woodbine House.
SCHOEDER, A. (1997) Socially Speaking, A Pragmatic Social Skills Programme for Pupils with Mild to Moderate Learning Disabilities. LDA.
SELIKOWITZ, M. (1997) Down Syndrome The Facts. OUP.
STAKES, R. and HORNBY, G. (1988) Meeting Special Needs in Mainstream Schools, A Practical Guide for Teachers. David Fulton.
STRATFORD, B. and GUNN, P. (1996) New Approaches to Down Syndrome. Cassell.
TILSTONE, C., FLORIAN, L. and ROSE, R. (1998) Promoting Inclusive Practice. Routledge.

Acknowledments

JANE BEADMAN, Educational Psychologist, Devon LEA.
GILLIAN BIRD, Psychologist and Director for Consultancy and Education, The Down Syndrome Educational Trust, Portsmouth.
BOB BLACK, Education Information Officer, DSA.
PROFESSOR SUE BUCKLEY, Professor of Developmental Disability, Department of Psychology at the University of Portsmouth and Director for Research and Publishing at The Down Syndrome Educational Trust, Portsmouth.
DR. STEPHANIE LORENZ, Independent Educational Psychologist, Manchester.
CECILIE MACKINNON, Education Liaison Officer, SDSA.
ERIC NICHOLAS, Development Officer, DSA.
Source:
http://www.dsa-uk.com/pdfs/DSA A4 12pp Secondary.pdf Revised: November 4, 2003.